Public health officials share school-based vaccination strategies

Jan 6, 2010 (CIDRAP News) – School-based immunization campaigns have helped federal officials reach one of their top priority groups to receive the pandemic H1N1 vaccine, and lessons learned from the experiences may help other districts, not only this season but also during future flu seasons, experts said today at a US Department of Health and Human Services (HHS) live webinar.

Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said districts in about two thirds of the states have hosted school-based pandemic vaccine clinics for students, and she said schools are also poised to ensure that children who should get their second dose—those ages 6 months to 10 years—are immunized in a timely manner, especially if the nation faces a third wave of infections later this winter or in the spring. The CDC recommends that children receive the second dose about 4 weeks after the first dose.

Two public health officials who played key roles in school-based immunization campaigns were on hand to share lessons from their experiences with webinar participants. Though both said their area schools had never hosted vaccine clinics before, they said previous pandemic planning activities provided a useful template.

Tom Lawrence, NREMT-P, director of the Rhode Island Medical Reserve Corps (MRC), said his state prioritized children to receive the vaccine first, so schools seemed like ideal venue for the vaccines. Public health services in Rhode Island are centralized because the state is so small, so it seemed like a natural fit for its one MRC unit and the Disaster Medical Assistance Team (DMAT) to assist with school-based vaccination, he said. "We have a strong relationship with the state department of health and participated in pandemic planning, so we were ready to help when they asked," Lawrence said.

Immunization clinic dates for each school were set randomly by a computerized lottery. "We vaccinated 73% of school children, which is extraordinarily high," he said, adding that uptake for the seasonal vaccine in the same age-group hovers around 30%. On Jan 11 Rhode Island school districts begin vaccine clinics to give students younger than 10 years their second vaccine doses.

Robin Wallin, RN, MSN, health services coordinator for Alexandria, Va., public schools, said strong ties with the state health department were also vital to the success of their school-based pandemic vaccine clinics. The campaigns reached 56% of school-aged children in Alexandria, with rates as high as 70% in some elementary schools and rates much lower in secondary schools. To ease administration of the second dose in children younger than 10, the district included permission forms in the paperwork for the first dose. The schools are just finishing the second round of shots, she said.

Both Wallin and Lawrence addressed the challenges involved in running school-based vaccine clinics. Wallin said communicating with parents was tough early on, especially parents who spoke different languages. "Schools were integral mouthpieces, helping answer questions about safety and addressing early anxiety among parents," she said. The already-daunting task of planning a vaccine clinic to take place during a busy school day was made even more difficult when events had to be rescheduled due to delayed vaccine supplies, Wallin said, adding that school administrators and public health officials also fielded lots of anxious calls from parents eager for their children to receive the pandemic vaccine.

To communicate with families, planners used several communication tools, from multiple mailings to Web site notices, to automated "robocalls" to students' homes, she said.

Lawrence said the school campaigns required a big logistics effort. "Warehouses where vaccine and supplies were kept were busy at 5:30 in the morning, with trucks still being repacked at 11 pm," he said. For 6 weeks before the school-based vaccination program began, Rhode Island's MRC held competency training sessions for volunteer vaccinators. "We had 749 people come through," Lawrence said.

The school campaigns have been successful, because communities, schools, and parents have been on board with the importance of getting the pandemic vaccine into the noses and arms of children, Lawrence and Wallin said.

"This was a genuine threat to their [parents'] kids, and they were willing to do whatever it took—people like their kids," Lawrence said. "The solution was presented to them, and they were willing to take it.

Enlisting the help of parent-teacher organizations was also helpful, both said. Parent volunteers not only helped by assisting during the vaccine clinics; they also helped communicate with other parents. Wallin said the presence of a school nurse in each of Alexandria's schools helped streamline all the vaccine activities.

Both public officials said their teams learned valuable lessons after conducting their first school-based vaccine campaigns. Wallin said officials hope to find better ways to boost vaccine uptake in secondary schools, and both urged their colleagues who are new to the activity to build stronger partnerships early with state health departments and other groups that can help, such as MRCs. "Don't wait for a disaster to build relationships," Lawrence said.

Schuchat said the CDC is gathering best practices from districts across the country that have hosted pandemic vaccine clinics. "Creativity is the beginning for actively building relationships that will be there in good times and in bad," she said, adding that in some communities, the pediatric health community has led the school vaccine charge, while others have enlisted visiting nurses organizations and firefighters to help vaccinate school children.

She said 2009 was the first year the CDC's recommendation that all children ages 6 months through 18 years receive their annual flu vaccine went into effect and added that federal officials hope school-based clinics become annual events: "We're hoping school vaccination will become the new normal."